Innovations in Cosmetic Eyelid Surgery

8/9/2019 Innovations in Cosmetic Eyelid Surgery

1/642 california optometry

Kami Parsa, MD

CE@Home

InnovatIons In CosmetICeyelId surgery

Intro

I 2007, h w 240,763 cic i pc p i h ui s.acci h aic sci ahic Pic s, hi w h hi

c cic p ipci (456,828) b i

(399,440). Bphp h bc h c p cic pc i

ci pic . I hi ic w wi iw h hi i ,

pic i ch, ppi ppi i ,

ic cpici, ii i , h c c i

cic i .

I h b i h h h p h . e i w c

wih h hi w ic b h w k cc hi . th

ic c i ch h i pibi i p ip-

i iii ci h hh xpi h chc,

i. Ch ci wih i i c pjc icc k i

ck ii pi q hh.

Bphp (gk bph = i + p = ch ) c b p

ci hic , bh. Fci bphp c

i h h b b , ici, ifi, i, pi

p . Cic p ip h ppc i

c h hiic ci . I ih c, h bph-

p i h i ji h i ,

h k.

Historyth c ci bphp w i h c ad, wh a

Ci C cib h xcii ki x pp i i De Re Medica.

th bphp bck 1817, wh g phici v g cib

chiq pii ii c b ci cc i h i. I 1907, C

mi w Cosmetic Surgery and the Correction o Featural Imperections, h bk

cic . th c ii hi bk, pbih i 1924, ci i

icii pp w i . F h 1940 c ,

bi h b ip p hi pc. I h p 10 , w

pi h i pic ji wh c ciz chiq w

-bih h chciic b i

i. th i i k ik , j b.

Anatomya ici b h wih . th skin h i i iq i

h i i hi ck h bc . th eyelid crease i b

xi h levator aponeurosis w h ki. ahh Cci h

i c, b 50% ai h . thi i h c ai

bphp i p. Orbicularis oculi i cici c ii -

h h ki h i i b h phhic bch h ci (ci vII)

i pib ci h i. th septum i h cci i ii

pi h bici c h kp h bi c hii. Wih i

th i i k ik, j b.


2/643www.coavision.org march/april 2009

chic bbi h , h p wk w

hii bi , which i h ppc

p b h w pp i. th

h fatty compartments h w i kw

h i, c p p. th pp i, i

c, h w cp, h i h

c p. th p p i pc b h

lacrimal gland i h pp i. th tarsal plate, which i p cci i, c b hh h

bckb h i. th medial canthus lateral

canthus p ip i chi h i h

bi b i p. a wk i h

c c i i xi which c i i i

pi cpi.

What are the changes associated withperiocular aging?ski, , ic, chi wi,

h w chic bbi biki

cib ch h i w .

Skin changes: a i-30 h ki h i

hi i ici. sw hi c i

xc ki i h pp i which wi c h c.

th dermatochalasia, which xci ki,

i cib hi cii.

Orbicularis oculi: a i pi, hi cici

c i pib i c. schi hi

c wih i cib h hi ki. I i

h chic hi c, cbi wih qii which i h ic wik w

h cw . th w p wik,

ic ic. dic wik pp wh w

i h pcic c. F xp, i w i

i ci i bw wi

ic wik i h cii h i

c. sic wik, h h h, p

i, wh h c i . Bx i xi

pic h c b ihibii h ci h

pcic c h pi (h h)

c ic wik.

Facial fat and volume: a w , h ci bi

bb i i i h c. a h ,

h ic c cib iic h w

i b, hi b h pi h

. I h p 10 h chiq i

pic ji k i cc hi ccp

. m chiq i pc

ic ijci hic i ch r

Ji, which hic ci pc i i 12

h. a i i ijci h pi w

ipci; hi ijci ii.

I h b i h i h

c wih i i.

Septum: thi c c wk i, i i

hii bi cibi h w

i b.

Orbital fat: n h bi pck c hi

hh wk p b h c b pi

bb wih i i i hw

k. o ic chiq w h xc

hi , i i wi h hw k.

(Pic bw i pi wh h i 20

which i h hw ppc.) u-

ch wii cib-

i piic p-bphp hw.

CE@Home

Figure 1 a 67 wh w i

bphp wih 18 . a c hi iic p-pi hw h whichk h pi k ci.

Preoperative Evaluationa w pi h h iii ci i which h

i wh i bhi hi/h

wh i i h w ik chi. a hi i h pi

h h i ic pi wih

iic xpci h ppi c.

a phhic, ic ic hi h b

k. ai i pi hi ci. e pi wih hi h h

schi p pci. Hw,

ch h hw h schi b ip

h h hi i pici h p

bphp. Pi wih ik

wi hi p ci ic

i k.

th ip p h p-pi x i

phhic xii ici i ci,



CE@Home

Lower Eyelid Blepharoplasty

thi i pc h h

iic ch i h p 10 ,

bc h ic c hi

i h ii h i

h. th cpic h

cib iic c i hi

pc. a i pi,

pp wh w hi w i p

bc b p i.

ai h h b i h wi:

1. Hi bi c wk

p

2. l i h ic wih i

3. exci ki hi

Figure 2 & 3 P-pi h p-pi ph 36 pi wh w pp i bphp. n h p-p-i c. Actual patient o Dr. Parsa.

Figure 4 & 5 P- p-pi iw pi wh w pp w i bphp. Actual patient o Dr. Parsa.

xc c , cpic x, ic p,

qc, wih ppb , i . a ic B ph i

pci w pw i h b wih i c. th B

fx hp pc i c ij xp kph. a pi

i ici pii b hi 10 b .

What determines if an upper eyelid blepharoplasty is covered byinsurance or Medicare?th wi h cii b

mic ic cpi

ci pp i bphp

ic ci, kw ci

[ h h] cic pc:

1. dci b h ciici h

ii chi (xc ki)

pi (p pp i).

2. P-pi phph h pi.

3. dc ip h 12 i pi i wih h

i p cp h i

p.

Upper Eyelid Blepharoplasty

W iiiiz pi. ech

i iq i ic bck-

b b xp i

x i c. th

p b ciz

iiiiz h p. upp i

bphp i xci ki c i p ib k

h pp i. a i pi

xci bi i b

h c.

di h ppi x h cibi ch h c ik i cc iiiiz p i h pi.

F h b h w i. I, h

hi bi i pii bck i h bi h bi

p i pic wih i i h. s pi

pich ki h w i i i ih h

ppc. m h i h ic i i h

wih ijci.


4/6

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Asian Blepharoplasty:th ai i i iic i i c h h cci i. appxi-

50% ai h i c. thi c ii h pp i i w

kw b i. Wh p, h hp ci h i c

w i h h cci i. I b c h ai pi

wih i c wh k cic ai bphp w k wiz,

h w hi hic k.

dpi h hp h c h pi w pc, i pi h i

c i ic b h pi. th i c ai c h h wi

p wiz cci c. H xp i c pii.

Figure 6, 7 & 8P c tp f c n c

Postoperative Carem cic i p ih c

hi c wih Iv i, hwi kw

wiih hi. Bii wi i h pp-

i wk i . Ic pck c wi

h 48 h. tpic pi b

wk cii wihi wk . a

pi phhic ibiic i i h pp-

i pi. s wk .

Revisional Eyelid Surgeryrii i ic cci pi p

p . s h cpici

ci pic h ci wih h i.

thi hpp wh h i xpic

ii wih h ic h i. th

cpic c cic, cci,

ii h . I i ip

ci hi wh i pi cic .

dpi h pcic pb, h c cci

i ip pc cpx i c-

ci. th ii i i

ci whi iii hic c.

th c cpi h i ii

i h ibii c h cp

pi cic . thi pb hpp wh

xc i ki w i h pi

. dpi h i h c, h

pc which c b cbi chi

h i ci cic c. F xp,

ki bhi h , which c ch h

x i ki c b h i h

i. th i-c c b b pi

i h w i. th cjci c b

b bwi c i h h.

ahh b, h h i i v-hp h

c. th c h i

cic i i ici p ppc.th c cic pb h

pi, b h c i wih bik ic.

th pi cpi i . thi

pb c b b pci ic chiq

pi bi. Ppi hw c b i b

pc ijci i h i bi.

Conclusionth cpic h

ch h . t ccp b

hic iii, wh i .

th i pc h i w

chiq wh h c i i i h

h xcii.

Dr. Kami Parsa is an oculoplastic and orbital reconstructive

surgeon. He is a native o Caliornia. Ater fnishing his residen-

cy in ophthalmology at USCs Doheny Eye Institute, he com-

pleted a two years ellowship in Oculoplastic Surgery at

Bascom Palmer Eye Institute in Miami. He is currently in private

practice in Beverly Hills and an attending surgeon at Cedars

Sinai Medical Center.


6/647www.coavision.org march/april 2009

8. Which h wi i ?. ai bphp i ci i

c.

b. th i c i b xi h

pi h ki.

c. Bx i ci .

. ocpic pciiz i cic, ii

cci h bi.

9. Which h wi i ?

. a bi h b i pp i

bphp.

b. rii c b p b hi i h ki, c b h

h, .

c. a h i i u-hp h c.

. Restylane i pic .

10. t F: rii i h b ci-

i pi b c hi

pi cic .

1. t F: Bphp w h 3 ccic p i h ui s i 2007.

2. Which c i pib ci h i?

. obici ci

b. l

c. mi c

. Fi

3. Wh i h bckb h i?

. ei c

b. obi

c. l. t p

4. Which h wi cib ch h

i w ?

. Chic bbi

b. gic

c. s xp

. ski

. a h b

5. t F: sic wik wh i

h pcic c.

6. Wh i pib b h ?

. exci ki hi

b. l ic

c. Hi bi

. a h b

7. Which i cii mic

ic cpi i h c pp i

bphp?

. P-pi ph

b. Pc

c. dii chi pi

. dc ip 12 i pi

i wih p . p

COA Members: No Charge/Non-Members: $30

o H Ce Ci. th i cip w

i May 15, 2009. s w wih ic

b :

Coa eci Ci

Po Bx 2591, sc, Ca 95812

Fx: (916) 448-1423 ei: ci@cii.

Transcripts will be mailed out ater the submission deadline.

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Innovations in Cosmetic Eyelid Surgery